Access to specialized medical services limited for HIV/AIDS patients

Medical professionals warned people living with HIV/AIDS a year ago to think carefully about returning to New Orleans where access to specialized medical services is limited.

Director Dr. Lynn Besh of the HIV Outpatient Program Clinic on Roman Street, said at the time: "If someone is considering coming back to New Orleans and they have a serious illness, we have told our patients please don't come back."

Now, Besh said her message is the same despite improving medical services. Surgical services are still hard to come by although neurology, gastrointestinal, pulmonary and gynecological services with hematologists and oncologists will return more strongly in the coming months.

"If they are healthy, I would say come on back," Besh said. "If they are really sick and established where they are, I'd tell them to think about it. It's not that we couldn't see them in clinic but the hospitals are always full, all of them. If someone had cancer I'd tell them the same thing."

Despite the fractured health system and the warnings, much of New Orleans' HIV/AIDS population has returned.

Fran Lawless, director of the New Orleans Office of Health Policy and AIDS Funding, said about 77 percent or 2,000 of 2,600 patients her office treated in 2004 returned in 2006. And as of July, the office has 1,621 patients putting it on pace to approach pre- Katrina numbers by year's end.

A total of 5,941 people are living with HIV/AIDS in New Orleans compared with 7,431 before the hurricane, a 20 percent decrease.

Lawless pointed to 13 of 17 HIV/AIDS health care providers reopening in the city as progress but she will not paint an overly rosy picture.

"Specialty care is still very limited not to mention the everyday challenges of living in New Orleans," Lawless said.

Lawless said some of the returning HIV/AIDS population is sicker than before the storm making a return even more problematic.

"When people evacuated, some went without their medications for long periods maybe because they didn't understand the system of care in the area they evacuated to or they were reluctant to share with their family that they were HIV-positive and needed special medications," Lawless said. "When you go off your medication the virus changes and you run the risk of getting sicker."

The stress of living in post-Katrina New Orleans is hard enough in terms of housing, public transportation, crime and a scarcity of emergency services and mental health hospital beds. Throw a serious disease such as AIDS into the mix and the result is potentially life threatening, said Besh.

"If it's difficult for you and your friends, can you imagine how difficult it is for a person impaired by HIV and AIDS?" Besh said. "You're dealing with mental health issues, depression and maybe a substance abuse problem. So now you're competing against the rest of the population for hospital beds that are at a premium in this city. And when you're depressed, you're typically too depressed to find any of these services. Putting one foot in front of the other is a challenge and that challenge is exacerbated by the recovery."

Noel Twilbeck, executive director of the NO/AIDS Taskforce in New Orleans, said people with HIV or AIDS should create a mental checklist before deciding to return.

"Do they have a place to stay?" Twilbeck said. "Will they have an income or a way to support themselves? What is their health like? If they are relatively healthy and have a place to stay and a way to support themselves they'll be OK. But if they're on a limited income with medical complications it may not be a wise move to return."

The NO/AIDS Taskforce is nearly back to pre-storm strength, Twilbeck said. The budget has increased 14 percent from $4.2 million to $4.8 million, but more duties are being performed because of the loss of several clinics. The staff is down only two people and a full range of services is available including case management, mental health counseling, a food bank and home-delivered meals.

Twilbeck still asks people to be cautious.

"Taking care of yourself health-wise and mental health-wise in an environment where the infrastructure is pretty damaged could be putting yourself in a precarious situation," he said. "Stress is only going to exacerbate the situation so it's important to minimize all stress. Taking care of something like HIV can be a full-time job and then you throw everything else on top that comes with living in New Orleans and it can be dangerous."

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